2003, 03-27 Permit App: 03002042 AdditionPROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE, WA 99260
509-477-3675
SPECIFIC SITE INFORMATION
Street Address:
2? S- "Am cN-
qS qS 4,r5 4,r5 LEY 0
Tax Parcel Number(s):
Legal Description:
Project Description: 0/4124 041 )444 lac.! P Lo04 G/ U//t/ G /I00 Al
Building Permit
❑ Change in Use
❑ Grading
❑ Manufactured Home Permit
❑ Relocation
❑ Sign
O Tenant (New/Change)
O Other
Department Use Only' •,
Phone 89/ —(p/Y 2-
l.i.
Water Detect/Pun chin .
. e.' ..
Scacr Dhrict/1'urec}nr -
.. - .
Road nidth •^
•Setbacks.:
Print
Left-
.... .. Rcar ..
.' Right
School Distdcr
Fire District. . ..
Zoning
'
‘2..621::
OWNER/APPLICANT INFORMATION
Il hill:w e nbo dwell be uwte,Yed recanlins ihn pm/nt
® O..ner
kg: v N 9E2644NL_
Phone 89/ —(p/Y 2-
l.i.
❑ Applicant
Phone
Pas
Mailing Address nn n
azgar i. 9ANtileN 61-
Mailing Arida..,
To Cal habitable space
City, State, Zip /
{.4'ya dj. epi-
99037
Cin, Suite, Yip
Gnu:taw lien hpc
❑ Contractor
Phone
1.as
0 Architect/Ifntinecr
Phone
Fa.
Mailing address
Mailing address
Cm, Slue Zip
Cin. Cute Yip
\\"A Seat Contractor hexes n
Contact name
PROTECT INFORMATION
• Building Information •,
Building height to peak
# of stories
/
\Iron floor sq 0.
2 e o
Unfinished basement sy 0
Utmcttstuns
('Hkri)K (frx lq )
To Cal habitable space
"td tluin.y 0
Hushed basement sy 0
Occupancy grout
Gnu:taw lien hpc
Garage sq. PI
Deck sq. ft-
Coit ni (scotch
I lea i $nu rce (electric. gas. CTC
Manufactured Home '
Sign- ::" '
Width:
Length:
What is the square footage of the sign
fact
I low high is the sign'
Year.
Make-
# of signs
Area of existing signs
Are there slopes greater than 30% on the proper.y2 (30 ft nse in 100 ft)
( �n/o) 0 les m --No
Proposed use
Value
Staff Repre.eniuis.
Relocation. "
Fii"e Safety
P i
Previous address
Is your property In a designated wildll fe habitat arca?
O Don't know 0 Yes f3'No
Fire Spnnkler
Tent
Paint booth Fire Alarm
Fireworks display
_
Are there slopes greater than 30% on the proper.y2 (30 ft nse in 100 ft)
( �n/o) 0 les m --No
Proposed use
Value
Staff Repre.eniuis.
Special Inspections,Reyuired? - . , "'
Noxi -Residential Etter
'Code- Compliance?":
Firm Name
Is your property In a designated wildll fe habitat arca?
O Don't know 0 Yes f3'No
Phone
Plans Dammer
('hone
Inspectors
Is there evidence of fill or excavation on the property?
0 Yes 13—No
Are there slopes greater than 30% on the proper.y2 (30 ft nse in 100 ft)
( �n/o) 0 les m --No
Arc critical or hvardous materials used or stored on site?
0 Yes dNo
Address
Staff Repre.eniuis.
Inspecmr
Phone
0 Concrete
0 Welding
0 Bolting
0 Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there stmctures on the property' EY -Yes O No
If yes, dentin, WI the plan
What is the current property sire?
(square feet or acres) 9 /// Si) 0
Is any part of the property within 250 feet of a shoreline?
Ifyes, rderr/ j5' on nie plats 0 Yes 21'No
What is the current use of this property?
Reit Ota LC
Is your property In a designated wildll fe habitat arca?
O Don't know 0 Yes f3'No
Will the site be served by a septic system' a -Yes O No
Is any part of the property within a 100 yr flood plain?
flys ,dentin, on site phi,'
0 Maybe D'bon t know 0 Yes 0 No
Are or will there be (yells located on the property?
]Viet, Iden/;' on the the plan 0 Yes B' No
Are there any mvetlands, streams or ponds within 200 feet of the property?
If yes, dentin, on de plan 0 Yes I71 --No
Is there evidence of fill or excavation on the property?
0 Yes 13—No
Are there slopes greater than 30% on the proper.y2 (30 ft nse in 100 ft)
( �n/o) 0 les m --No
Arc critical or hvardous materials used or stored on site?
0 Yes dNo
DEPARTMENT USE ONLY
Is rhe property in a designated Stomnvater Control Area?
O Yes
O No "
Is public sewer available to the site? ; " ❑i.YeS , O' No
. ... • - ..
Is the property inside the ASA? 0 Yes
OYes '
-0 No
0 No
Is public water available to the site? : - O', Yes O. No
• '- -
"
Is the property inside the PSSA? 0 Yes
0 No .
Is'the property located within 1000 feet of a Natural Resource Area?
0 Yes 0 No '. . . , ,
(Dire Recut ed
Staff Repre.eniuis.
METHOD OF PAYMENT
VISA
❑ cAsii D (,1[1,A.K.❑
DIJCWVER
FAXED PERMITS \VILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATIS.
EXPIRES
It;\N KC '\I21) NUMBER
AU'I'I 111121%f:D SI GNA"I'UIRR.
SUBTOTAL
. • TOTAL FEE
'MINIMUM PERMIT FEE /S DS LW P L ES S E
- MAKE CI HICKS RUMBLE TO SPOKANE
COUNTY PERMIT KEN.' I EA
Project Number. 030020.12 Inv: 1
Application
Date: 3/27/21103 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use. RES ADD - EXPAND FAMILY ROOM Contact: BERGDAHL, KEVIN
Address: 2925 S BANNEN CT
C - S - Z: VERADALE WA 991137
Setbacks: Front Leff Right: Rear: 38 Phone: (5119) 891-6142
Group Name.
Site Information: Project Name
Plat Key: 0115415 Name: EVERGREEN PT 118TH ADD District: F
Parcel Number 45263.4804
Block: Lot.
SiteAddress: 2925 S BANNEN CT
VERADALE, WA 99037
Location" VER
Zoning: UR -3.5
Warta District.
Area: 1,518.00 Acres
Urban Residential 3.5
Owner: Name : BERGDAHL, KEVIN
Address: 2925 S BANNEN CT
VERADALE WA 99037
Hold. ❑
Width. 0 Depth: 11 Right Of Way (ft): 50
Nbr of Bldgs: 1 Nbr of DwcIIIngs: 1
Review Information: - -
Review
Site Plan Review
Released By.
Plan Review
Permits:
Originally Released: 3/27/2003 By. ,jshatto
Released By: .
Originally Released: 3/27/2003 By: jshatto
Operator: JAS Printed By. JAS
Print Date: 3/27/2003
Project Number: 03002042 Inv: 1
Application
Dale: 3/27/2003 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Contractor. OWNER
Building Permit
Firm: OWNER
Phone:
Building Characteristics
Const Category: Addition Group: Type:
Nbr Of Dwellings: Occupant Load: Building Height: Stories.
Bldg W x D: x Building Sq Ft: Sprinklers. ❑
Req Parking: Handicap Parking Critical Materials ❑
This Application: Total Project:
Description Grp Type Notes Sq Et Valuation Sq Ft Valuation
RES ADD R-3 VN 200 $13,200 00 200 $13,200.00
Item Description
RESIDENTIAL VALUATION
STATE SURCHARGE
RESIDENTIAL SURCHARGE
Contractor: OWNER
Item Description
GAS PIPING
GAS LOG OR GAS INSERT
MINIMUM FEE ADJUSTMENT
Notes:
Payment Summary:
Permit Type
Building Permit
Mechanical Permit
Totals: 200 $13.200.00 200 $13,200.00
Units Unit Desc
1 Y OR BLANK
1 Y OR BLANK
I Y OR BLANK
Permit Total Fees:
Mechanical Permit
Firni: OWNER
Phone.
Fcc Amount
$213.00
54.50
$46.86
$264.36
Units Unit Desc Fee Amount
1 # OF UNITS 51.00
1 NUMBER OF 510.00
1 Select $24.00
Fcc Amount
$264.36
535.00
Permit Total Fees: $35.00
Invoice Amount
$264 36
535.00
$299.36 $299.36
Amount Paid
50.00
50.00
Amount Owing
$264.36
535.00
$0.00 $299.36
Disclaimer:
Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information
contained within to he true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will he
complied with. Subsequent issuance of a permit shall not be construed to he a permit for, or an approval of, any violation of any of the
provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: JAS Printed By. JAS
Print Date: 3/27/2003
CURB DROP
STA 6+81.79
ELEV.=2024.72 T.C.
1.19`
7.83'1
r -
I
L7:D3•
POND BOTTOM NOl Fi
ELEV.=2023.72 LIS, - . 0 if
24 HRS. PRIG \ :10 C0>,g7r2U 7
11
BANNEN COU Y ,-riYP Ar CURB
N /I
14.07 \
DRAINAGE
EASEMENT
PROPERTY LINE
LL/
b=57.22
7 —
– 10' UTILI
EASEMEN
EXPIRES
This sne clani5 f;
obis -Tuna a atUlm.y rn:F m
representation of the preponak All known propbrty
lines/dimensions. curb Tinos. structures and easements
have been identified. Also indicated are wetlands,
bodies of water, steep slopes or Other crii'cal areas.
Signed:
Date' 2. 27-22.
-Ism 1,-i
euh-iced for thepurposa o
124.69'
RECEIVED
APR 2 7 1994
SCALE: 1" =20'
LOT 4, 3LOCK 23
EVEPCREEN POINT 8TH ADDITION
DATE: 4/2194
INLAND
. PACIFIC
l ra.4- ENGINEERING
707 Went 7th • Suite 200 (509) 458-6840
Spokane, WA 99204 FAX: (509) 468-6844